The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh.

BACKGROUND: Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. METHODS: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. RESULTS: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. CONCLUSIONS: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. PATIENT OR PUBLIC CONTRIBUTION: Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families: the Strong Families Trial.

BACKGROUND: Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years. METHODS: Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention. DISCUSSION: This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status. TRIAL REGISTRATION: This study is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12619001019190 ). Registered 16 July 2019.

Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study.

BACKGROUND: Although previous research suggests a relationship between chronic low back pain (cLBP) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals. The aim of this study therefore was to examine the relationship of regional and total body adiposity to pain and disability in cLBP individuals. METHODS: A preliminary explorative study design of seventy (n = 70) adult men and women with cLBP was employed. Anthropometric and adiposity measures were collected, including body mass index, waist-to-hip ratio, total body adiposity and specific ultrasound-based abdominal adiposity measurements. Self-reported pain and disability were measured using a Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) questionnaires respectively. Relationships between anthropometric and adiposity measures with pain and disability were assessed using correlation and regression analyses. RESULTS: Significant correlations between abdominal to lumbar adiposity ratio (A-L) variables and the waist-to-hip ratio with self-reported pain were observed. A-L variables were found to predict pain, with 9.1-30.5 % of the variance in pain across the three analysis models explained by these variables. No relationships between anthropometric or adiposity variables to self-reported disability were identified. CONCLUSIONS: The findings of this study indicated that regional distribution of adiposity via the A-L is associated with cLBP, providing a rationale for future research on adiposity and cLBP.

Pain reported during prolonged standing is associated with reduced anticipatory postural adjustments of the deep abdominals.

Within the context of low back pain, the measurement of deep abdominal anticipatory postural adjustments (APAs) during rapid limb movement has received much interest. There is dispute about the association between APAs and back pain. Moreover, there is limited evidence examining compensatory postural adjustments (CPAs) in back pain. This study examined the relationship between APAs and CPAs with pain reported in the low back during 2 h of prolonged standing. Twenty-six participants with no history of severe back pain performed 2-h prolonged standing. APAs and CPAs of the deep abdominal muscles (transverse abdominis/internal obliques) were measured by surface electromyography during rapid shoulder flexion and extension. APAs and CPAs measured pre-standing revealed symmetrical anticipatory activity, but an asymmetry between the different sides of the abdominal wall for CPAs. APAs and CPAs measured pre-standing were not associated with pain reported during standing. For the whole group, APA amplitudes were reduced post-standing during shoulder flexion (p = 0.005). Pain reported during standing was associated with the changes in APA amplitudes post-standing (rs = 0.43, p = 0.002). These findings support previous research using hypertonic saline injections to induce back pain that showed reduced APA amplitudes, and extends findings to suggest pain does not effect compensatory postural adjustments.

Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content.

Social media platforms are used for support and as resources by people from the endometriosis community who are seeking advice about diagnosis, education, and disease management. However, little is known about the scientific accuracy of information circulated on Instagram about the disease. To fill this gap, this study analysed the evidence-based nature of content on Instagram about endometriosis. A total of 515 Instagram posts published between February 2022 and April 2022 were gathered and analysed using a content analysis method, resulting in sixteen main content categories, including "educational", which comprised eleven subcategories. Claims within educational posts were further analysed for their evidence-based accuracy, guided by a process which included fact-checking all claims against the current scientific evidence and research. Of the eleven educational subcategories, only four categories (cure, scientific article, symptoms, and fertility) comprised claims that were at least 50% or greater evidence-based. More commonly, claims comprised varying degrees of evidence-based, mixed, and non-evidence-based information, and some categories, such as surgery, were dominated by non-evidence-based information about the disease. This is concerning as social media can impact real-life decision-making and management for individuals with endometriosis. Therefore, this study suggests that health communicators, clinicians, scientists, educators, and community groups trying to engage with the endometriosis online community need to be aware of social media discourses about endometriosis, while also ensuring that accurate and translatable information is provided.

Exploring the relationships between heritage tourism, sustainable community development and host communities' health and wellbeing: A systematic review.

Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681.

Older adults' perspectives towards optimizing lifestyle behaviors and strategies to support healthy brain ageing during COVID-19 restrictions.

Introduction: It is unknown how the impact of COVID-19 restrictions has affected brain healthy behaviors that contribute to dementia risk reduction in older adults. Our aim was to explore perspectives of older adults on lifestyle behaviors that support positive brain health and dementia risk reduction during and following COVID-19 restrictions. Methods: Community-dwelling older Australians (N = 159) during June to October 2021 (the second wave of COVID-19 restrictions) who had taken part in a pre-post dementia risk reduction intervention program were invited to discuss the impact of COVID-19 on their lifestyle behaviors. Semi-structured interviews explored individual's adaptability to pandemic restrictions, intended behavior changes following restrictions easing, and feedback on the effectiveness of ongoing intervention programs for sustaining brain health. Thematic data analysis was performed using a deductive approach. Results: Participants had an average age of 73.1 years (SD = 5.6; range: 65-90), majority were female (74.7%), lived in a major city (82.2%) and mean 9.5 years (SD = 1.7) of education. Older adults' views about lifestyle prevention strategies during the pandemic were both positive (e.g., more spare time and adaptive leisure activities) and negative (e.g., social isolation, lack of motivation, adverse emotions). Participants highlighted a continuous conscious effort to adapt certain brain healthy behaviors despite the persistence of adverse impacts of COVID-19 restrictions. Participants also expressed the intention and desire to revert to their previous lifestyle before the COVID-19 pandemic or a sense of the 'new normal'. Conclusion: This formative research will inform future interventions targeting dementia risk reduction to consider the immediate and lasting effects of COVID-19 restrictions on older adult's lifestyle behavior.

Pilates exercise or stationary cycling for chronic nonspecific low back pain: does it matter? a randomized controlled trial with 6-month follow-up.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: This is the companion study to a previous publication that presented 8-week pain, disability, and trunk muscle motor control results. The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs (FAB) in patients with chronic nonspecific low back pain, and provide 6-month outcome data for all self-report measures. SUMMARY OF BACKGROUND DATA: It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB, and concomitant levels of pain and disability. METHODS: Sixty-four patients with low back pain were randomly assigned to 8 weeks of specific trunk exercise group (SEG), or stationary cycling group (CEG). Self-rated pain, disability, catastrophizing and FAB scores were collected before, immediately after (8 wk), and 6 months after the training program. Clinically meaningful improvements were defined as greater than a 30% reduction from baseline in pain and disability scores. "Intention-to-treat" principles were used for missing data. Per-protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions. RESULTS: At 8 weeks, disability was significantly lower in the SEG compared with the CEG (d = 0.62, P = 0.018). Pain was reduced from baseline in both the groups after training (P < 0.05), but was lower for the SEG (P < 0.05). FAB scores were reduced in the SEG at 8 weeks, and in the CEG at 6 months. No between-group differences in FAB scores were observed. Similar reductions in catastrophizing in each group were observed at each time point. At 6 months, the overall data pattern suggested no long-term difference between groups. Per-protocol analysis of clinically meaningful improvements suggests no between-group differences for how many patients are likely to report improvement. CONCLUSION: Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved. LEVEL OF EVIDENCE: 2.

No relationship between body mass index and changes in pain and disability after exercise rehabilitation for patients with mild to moderate chronic low back pain.

STUDY DESIGN: A retrospective multicenter study. OBJECTIVE: To investigate the relationship between body mass index (BMI) and changes in pain and disability resulting from exercise-based chronic low back pain (cLBP) treatment. SUMMARY OF BACKGROUND DATA: Past research has shown evidence of a relationship between BMI, a measurement of obesity, and cLBP. Exercise is a known beneficial treatment for cLBP. However, it is unclear if exercise-induced changes in pain and disability are related to baseline levels of, or changes in, BMI. METHODS: One hundred and twenty-eight (n = 128) males and females with cLBP performed 8 weeks of exercise, consisting of 3 to 5 exercise sessions (minimum of 1 supervised session) per week. Outcome measures included BMI and self-reported pain and disability. BMI was calculated as weight divided by height squared (kg/m). Pain was measured using the visual analogue scale and disability was measured using the Oswestry Disability Index. Correlation, regression, covariance and likelihood ratios analyses were used to examine the relationship between BMI and self-reported pain and disability changes. RESULTS: No baseline relationships between BMI and self-reported pain (r = -0.083, P = 0.349) and disability (r = 0.090, P = 0.314) were observed. There was no relationship observed between baseline BMI (P = 0.938, P = 0.873), or changes in BMI (P = 0.402, P = 0.854), with exercise-related changes in pain and disability, respectively. No relationships between baseline BMI or BMI changes with pain and disability at baseline or after exercise were observed on the basis of pain and disability subgroups. BMI was not a predictor of exercise-based pain and disability changes. CONCLUSION: There was no significant relationship between BMI and self-reported pain and disability in cLBP participants. BMI was not a predictor of exercise-induced changes in pain and disability. The reliance on BMI as a sole measurement of obesity in cLBP research may be unwarranted.

The differential effect of metabolic alkalosis on maximum force and rate of force development during repeated, high-intensity cycling.

The purpose of this investigation was to assess the influence of sodium bicarbonate supplementation on maximal force production, rate of force development (RFD), and muscle recruitment during repeated bouts of high-intensity cycling. Ten male and female (n = 10) subjects completed two fixed-cadence, high-intensity cycling trials. Each trial consisted of a series of 30-s efforts at 120% peak power output (maximum graded test) that were interspersed with 30-s recovery periods until task failure. Prior to each trial, subjects consumed 0.3 g/kg sodium bicarbonate (ALK) or placebo (PLA). Maximal voluntary contractions were performed immediately after each 30-s effort. Maximal force (F max) was calculated as the greatest force recorded over a 25-ms period throughout the entire contraction duration while maximal RFD (RFD max) was calculated as the greatest 10-ms average slope throughout that same contraction. F max declined similarly in both the ALK and PLA conditions, with baseline values (ALK: 1,226 ± 393 N; PLA: 1,222 ± 369 N) declining nearly 295 ± 54 N [95% confidence interval (CI) = 84-508 N; P < 0.006]. RFD max also declined in both trials; however, a differential effect persisted between the ALK and PLA conditions. A main effect of condition was observed across the performance time period, with RFD max on average higher during ALK (ALK: 8,729 ± 1,169 N/s; PLA: 7,691 ± 1,526 N/s; mean difference between conditions 1,038 ± 451 N/s, 95% CI = 17-2,059 N/s; P < 0.048). These results demonstrate a differential effect of alkalosis on maximum force vs. maximum rate of force development during a whole body fatiguing task.

Specific trunk and general exercise elicit similar changes in anticipatory postural adjustments in patients with chronic low back pain: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVE: To compare changes in self-rated disability, pain, and anticipatory postural adjustments between specific trunk exercise and general exercise in patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Chronic low back pain is associated with altered motor control of the trunk muscles. The best exercise to address altered motor control is unclear. METHODS: Sixty-four patients with chronic low back pain were randomly assigned to a specific trunk exercise group (SEG) that included skilled cognitive activation of the trunk muscles in addition to a number of other best practice exercises, whereas the general exercise group performed only seated cycling exercise. The training program lasted for 8 weeks. Self-rated disability and pain scores were collected before and after the training period. Electromyographic activity of various trunk muscles was recorded during performance of a rapid shoulder flexion task before and after training. Muscle onsets were calculated, and the latency time (in ms) between the onset of each trunk muscle and the anterior deltoid formed the basis of the motor control analysis. RESULTS: After training, disability was significantly lower in the SEG (d = 0.62, P = 0.018). Pain was reduced in both groups after training (P < 0.05), but was lower for the SEG (P < 0.05). Despite the general exercise group performing no specific trunk exercise, similar changes in trunk muscle onsets were observed in both groups after training. CONCLUSION: SEG elicited significant reductions in self-rated disability and pain, whereas similar between-group changes in trunk muscle onsets were observed. The motor control adaptation seems to reflect a strategy of improved coordination between the trunk muscles with the unilateral shoulder movement. Trunk muscle onsets during rapid limb movement do not seem to be a valid mechanism of action for specific trunk exercise rehabilitation programs.